Provider First Line Business Practice Location Address:
2690 WILLIAM PENN AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15909-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-322-3239
Provider Business Practice Location Address Fax Number:
814-322-3459
Provider Enumeration Date:
05/14/2007